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Why the iPad will not be used for Health Care IT

Share By Jared Houck January 29, 2010

With the much-hyped release of the iPad, Apple has their sights set on the Amazon Kindle’s market share; and I’m sure they will do well. However, some health care IT industry heavyweights have gone so far as to suggest that the iPad will be greatly utilized in the health care setting and revolutionize the way we do business.

While I do think the iPad is incredibly shiny and is great computer replacement for your grandma, I think it’s a bit of an exaggeration to suggest that it will ever be fully adopted by Healthcare IT shops. Here’s why:

1. It’s a Tablet.

We have this on-going love affair with the idea of the tablet based computer. We can imagine the freedom to roam about, simplified interaction, minimal commitment, and the pride of knowing that we have something no one else has. In practice, however, tablet computers have always been an awkward lot. Too big to put in your pocket, too small to see enough data on the screen, too heavy to carry around for very long, and too expensive to set down any where. I don’t want to even think about how much MRSA/ORSA could be cultured from the screens.

Windows 7 icon2. Windows OS.

Most Healthcare IT shops are PC based (or for you old schoolers – IBM compatible). The infrastructure to support a PC is already in place. Yes, there are MacBooks and iPhones scattered throughout the hospital staff, but 99% of the devices deployed in the facility are running a Windows-based OS. Not that Apple’s OS X isn’t a capable operating system, it absolutely is. Unfortunately, the iPad doesn’t harness the full* power of OS X; it actually runs a modified and backwards compatible version of the iPhone OS  (a derivative of OS X stemming from Apple’s Darwin code*).

*corrections

3. iTunes.

I won’t tread too far into my personal loathing of this application. Let’s just say, it would be incredibly complex to support the software needs of an array of iPads related to their vampiric tethering to this application. Apple does provide business grade solutions for software deployment, but at some point, someone will plug this baby into their home computer to sync their music, and your hospital help desk will immediately place a large bounty on the head of the manager that  approved this venture. Also, there are very few no CCHIT certified health care software products that offer interfaced iPhone/iPod Touch apps. And no Epic, Haiku doesn’t count yet.

4. Price.

For the 16GB, 32GB and 64GB Wi-Fi only models, you will shell out $499, $599, and $699. Or add $130 for Wi-Fi-plus-3G models and you’re looking at $629, $729, and $829; plus the $30/month 3G service fee from AT&T. Basically, you could buy 2-3 fairly capable PC-based netbooks for the price of 1 iPad.

No expansion ports here

5. Multitasking.

PCs have it. The iPad does not (at least until OS4).

6. Expansion ports.

There are no included USB ports of any sort. Instead, you have to purchase a $29 Camera Connection Kit that includes two dongles: one for USB and one for SD cards. The 30-pin docking connector used to sync and charge doesn’t officially count.

7. WiFi + AT&T 3G = still not connected.

Most hospitals have a pretty solid WiFi network. It’s too bad your IT security guys are reluctant to authenticate your device allowing you to connect to it. Considering AT&T’s nose-thumbing at actually improving their coverage, it is also likely that you won’t be able to connect to the web via your cellular connection within the walls of your facility anyway.

8. Safari web browser.

The web browser built into the iPad / iPhone OS is based on the Safari rendering engine. Many applications do not properly support the Safari browser as most healthcare software vendors still use Internet Explorer as the gold standard.

*Update – As of April 14th, you can download the Opera Mini web browser from the Apple App Store. Unfortunately, actually using Opera Mini to view medical records could be a teensy weensy  HIPAA violation.

Hewlett Packard Slate runs XP, Vista, or Win79. HP Slate – the idea (but really the bulletproof Lenovo version).

This little gem from Hewlett Packard could quite possibly be the game changer for tablet PC use in the healthcare setting. Windows OS (XP, Vista, or Win7), check. Deploy-able with current infrastructure, check. Price below <$600. Multitasking, check.  USB expansion ports, check. WiFi, check. Hundreds of gigabytes of hard drive storage that I can directly access, check. Internet Explorer, yawn…but check. Touch screen, check.

10. Other silly bemoanings.

No wireless synchronization. No Adobe Flash support in the web browser, 4:3 screen aspect ratio, relative lack of storage space, kludgy copy and paste, projected 10 hour battery life (which really means 6-8 hours of use), and no on-board camera.

Is Lenovo down in the lab making a battle-ready version? Dear Lord, we hope so.



Tags: Apple, HP Slate, Infrastructure, iPad, iTunes, Security
Jared Houck

About this Author: Jared Houck

a.k.a. "Nursie Boy" - Jared Houck is an RN currently working as a Clinical Systems Analyst. His nursing background includes stints in the Operating Room and Pediatric Intensive Care. Jared has been involved with the development, build, and implementation of electronic documentation systems for Inpatient Nursing, Critical Care, Respiratory Therapy, Labor & Delivery, Psychiatry, Rehabilitation, Occupation Therapy, and Physical Therapy. Jared has presented his work with electronic documentation design at both regional and national conferences.

  • Jared:
    You present excellent points as to the future of the iPad and its role in Electronic Medical Records. We see many docs betting that this EMR/iPad app as a alternative to Saas or Client-server configs.
  • Interesting article re: Flash points out why the iPad is the perfect device for health care professionals from a security standpoint:

    "If you look at the list of what the iPad is missing, you&#39;ll discover a security wonk&#39;s greatest dreams:

    -Difficult or impossible for unauthorized background processes to run.
    -One-to-one user-to-system mapping obviates the need for RBAC.
    -Limited software availability with baroque approvals process.
    -Limited (8 pages at a time) browser with mature engine and standards support.
    -Limited local storage with only api access to locally stored information.
    -Limited server processes listening (just the iTunes mDNS listener).
    -No Adobe Reader (uses an Apple authored PDF interpreter).
    -No Adobe Flash.

    http://www.csoonline.com/article/592038/Will_iP...
  • I found your post interesting. I couldn&#39;t agree with you more. I posted a few additional points you can check out at: http://www.macadamian.com/insight/healthcare_de...
  • JimB
    On #8 and Opera, you seem to have a weak grasp. The directive is to keep individuals not authorized to do so from sseeing your medical records, but nothing is iron-clad. Matter of fact, today, your file could be left on a counter at the Nurse&#39;s station, and someone could take a peak. The chances of someone hacking the Opera data center in Norway and seeing an individual&#39;s records are much more remote.
  • lavanian
    BTW iPad?!! What&#39;s wrong with Apple&#39;s grammer ! Why is it not Ipad, I-Pad or Ipad. Maybe this is a subtle way of saying that I (the person who bought the iPad) am of no (or low) importance (note the &#39;i&#39; ) as compared to the Pad (capital &#39;P&#39; - belonging to Apple)!
  • Apple has little to worry about if that is the best you can come up with.
  • 1) I would have thought a tablet would be better than a keyboard in terms of keeping clean.
    2) Yes, many healthcare organisations still use Windows... but how long can they keep using 3.1?
    3) I agree I still don&#39;t warm to iTunes interface/limitations... but on the positive side I&#39;ve never heard of anyone picking up a virus there.
    4) It&#39;ll come down in price but most of us know that cheap computers offer very bad value.
    5) OS4, ie it won&#39;t be an issue in a couple of weeks.
    6) wireless offers less places for infection to fester.
    7) just tell your IT people you&#39;re not going to carry around an ethernet cable any more!
    8) Opera zings and looks like it&#39;ll be available in a few days.
    9) I have a soft spot for Lenovo quality; even though the reputation was built on IBM quality; I&#39;m still not sure Lenovo are completely safe hands.
    10) Flash - You&#39;re not supposed to be playing games on the thing!
    11) The prediction. You&#39;ll be using it and loving it within a year :)
  • 1. You&#39;re right about cleaning. A pad should be easier. I was mainly thinking about the increased portability and the likelihood of going from one patient room/nurse station to another. The risk for spreading bugs increases dramatically, unless the clinician never actually sets the device down.

    2. Some facilities are still on Windows XP (circa 2001). Changing operating systems is a huge endeavor for a facility of any size. Many are still waiting to see if Win7 will have the same fallout as Vista did.

    5. OS4 brings application state snapshots that very much resemble Multitasking = AWESOME.

    7. And they would laugh and send me on my merry way :)

    8. Good point about Opera. I&#39;ve only used Opera on mobile platforms. I&#39;ll give it a spin on the desktop this week.

    11. Oh, if someone would only let me test an iPad for a while!
  • Great post. More astute than the author of this much commented upon article.

    PS: Opera is available for iPhone/iPad now -

    http://itunes.apple.com/app/opera-mini-web-brow...

    (Be aware that Opera Mini directs all traffic thru it&#39;s servers so one wonders whether there could be security issues.)
  • I just installed the Opera browser on my iPhone and on hardwired (to hospital intranet) desktop. Opera doesn&#39;t seem to work on non-W3C compliant applications. Is Opera (desktop) also directing its traffic through their servers to do the heavy lifting? If so, Opera Mini on iPhone/iPad doesn&#39;t help at all - AND to your point, has the potential for major security implications. Have you had any luck?
  • Opera Mini does pass requests through their servers, which can be a problem if the hospital is blocking outside IP addresses and also brings up potential security concerns.

    In my limited testing, I like Safari more as it renders pages better and I didn&#39;t see much of a speed advantage.

    PCMag did a nice review:

    http://www.pcmag.com/article2/0,2817,2362599,00...
  • Man, Robert...you never let up, do you? I am a real person, so again, please keep it civil.

    And good add BTW on the new Opera Mini app - very exciting.
  • Sorry. You&#39;re right and I apologize.
  • mondomori
    A Cloud Services Device in your hand -- that&#39;s why the iPad looks so "big", and why it deliberately shuns traditional features from personal computers. That&#39;s why people hate it. And why some love it.

    Healthcare IT has struggled for a long time to bring the sort of services needed, to everywhere that they are needed. It is an area that might just be overtaken one day by companies that can build services for health on a larger and more integrated scale, and supporting an iPad will be trivial. But that will take maybe a decade. But it will leapfrog traditional healthcare IT systems that were built for a personal desktop metaphor.

    The future is a myriad of connected screens with simple interfaces everywhere, synced to massive data centres. The iTunes store showed people were willing to use a music service. The iPhone app store showed people were willing to hand over "admin" tasks to a service that made getting software and installing it a task anyone can do walking down the street with three taps of their thumb.

    Presumably a giant integrated service is what healthcare has wanted all along? Well the PC doesn&#39;t fit that. But it will take time. Much of existing software will need to be rewritten. But the hardware continues to become lighter and cheaper, and more ubiquitous, and networks provide ways to connect everything. So what matters most now is the actual data, and that always needed centralising anyway. So you&#39;re always wanted a service. PCs and small servers in departmental back rooms were just never architected for that sort of distributed scale.

    All that data needs to be managed by professionals. Then it just needs to get where it is needed in the most convenient manner possible. A PC filesystem is pretty much irrelevant to that now, as a user exposed system. Multitouch and efficient CPUs and better battery technology and wider wireless networking is making the convenience factor ever more important. We won&#39;t necessarily be using Apple hardware in ten years, but the writing is on the wall for "personal" computing. Massive medical cloud services conveniently accessible by all who need them. That&#39;s the future.
  • Now that I have an iPad &#39;in my hand&#39; I can report good success in the medical office and hospital environment. I can access our office EMR system just fine, along with our PACs system and the local hospital EMR works fine too (McKesson). The Citrix Receiver is on the App Store (free) too, although I have not used it . I expect it to work well for Remote Desktop Services (Terminal Services) with Windows and Windows-based EMR systems.

    All in all, a wonderful addition to my doctor&#39;s bag!
  • housewhisperer
    The problem so far with tablets has been the lousy software. As a physician, I would like an app that I could dictate into, write on, and tap to access lab and imaging data. So far, that doesn&#39;t exist in any meaningful way. Also, templates are not useful to our way of thinking. The lack of camera, full OS and flash are all pluses in terms of maintaining privacy and keep people focused on the task. What advantage is there, after all, to running a simple information exchange program on a PC?
  • phaigh1
    Based on more than 3 years of prototyping Tablet & Laptop PCs as mobile devices for physicians and clinicians - see http://www.healthcareitnews.com/news/m3-brings-... we know they work well in HC. Trouble is the IPad does not qualify as a Tablet PC. Here are some features that would need to be available for the IPad to be suitable. A Windows Boot, like the Mac, so that applications developed for a Windows environment can run unchanged; a Video Camera, even better 2, one facing the user and one on the other side, like the Sony laptop (the Intel sponsored Motion Computing device has one camera on the wrong side); an available Unified Communications solution like Cisco or Microsft offer, supporting video-conferencing & Presence Management; EVDO-LTE connectivity so that the superior Verizon Wireless data service can be used; replaceable battery so that auxiliary batteries can be carried so that 8+ hours of continuous use can be supported; and that&#39;s just for starters........
  • Please continue your prototyping as you have a ways to go.

    1. "Tablet" qualification (whatever that is) is obviously not a plus, as the slew of PC tablets over the years has been a complete failure.

    2. Windows, as stated above, is no longer a requirement. More and more vendors, even in the health field, are supporting non-proprietary, open standards. Just look at the number of EMR vendors with iPhone apps!

    3. One or two video cameras is NOT necessary for health-related applications and may even pose a security or privacy concern.

    4. EVDO is dead and LTE is not out yet. 3G or 4G is not required in a hospital or physician office. WiFi with WPA2 works perfectly well.

    5. The 10 hour life of the iPad is perfect for hospital and physician use. At best this is a minor issue anyway.
  • phaigh1
    See below

    Peter J. Haigh, FHIMSS
    412 720 6838
  • Verizon steps up to the plate.

    Well played Mr. Haigh. All solid points. Feel free to elaborate, as I&#39;m sure your involvement/experience with the M3 device has much relevance in this discussion.

    I see that your article was from 2007. What&#39;s the status of the M3 device as of 2010? Sounds promising, but I can&#39;t find any other info about it. Is it still in development or is it being offered commercially?
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